Traditional Medicare consists of Part A and Part B benefits, which lay the ground for other additional coverage such as Medicare Advantage and Medicare Supplements. These supplement plans, also called Medigap, are healthcare insurance plans provided by private insurance companies. They take care of the out-of- pocket costs that Traditional Medicare does not cover. Medicare Advantage (MA) is a government program offered by other private insurance companies as an alternative to Medicare. It’s important to note that when you’re enrolled in a MA plan you can’t enroll in a supplement plan. That’s why it’s important to educate yourself on all your plan options prior to purchasing one. Below we’ll review the difference between Medicare Advantage vs Medicare Supplement plans.
Medicare Advantage vs Medicare Supplement
MA is also known as Medicare Part C. Aside from hospice care, which is covered by your Part A, Medicare Advantage plans offer all the same benefits of Original Medicare. The difference is these plans sometimes include additional benefits like vision, dental, hearing and prescription drug coverage that Original Medicare doesn’t include. These plans give you the convenience of having benefits all under one plan, but this can also limit you on the amount of coverage you can get.
Medicare Supplements are provided by private insurance companies to cover specific healthcare costs that your Original Medicare doesn’t cover. Depending on the plan you choose they can cover your deductibles, premiums and co-payments. There are 10 plan options lettered A-N, they’re all standardized. This means that regardless of what carrier you choose, the benefits will be the same. The only difference between the carriers are the prices they charge for each letter plan. These plans do not cover prescription drug coverage, enrolling in a standalone Medicare Prescription Drug plan will cover your prescription costs. Recipients that choose to go with Original Medicare usually enroll in a supplement plan as well as a prescription drug plan to get the full amount of coverage they need for their healthcare costs.
Frequently Asked Questions
Which Plan Lets You Choose Your Doctors & Hospitals
- With an Advantage plan you can only see in-network doctors or hospitals. When an supplement plan you can see any doctor and go to any hospital in the US that accepts Medicare
Which Plan Will Protect Me Against High Out of Pocket Costs
- An Advantage plan could leave you responsible for the plans max out of pocket costs, MOOP, which can be as high as $10,000 per year
Which Plan Requires a Referral to See a Specialist
- Usually, with an Advantage plan you need a referral from your primary care doctor to see the specialist. With a supplement plan you do not need a referral
Can I Switch Plans Whenever I Want
- With an Advantage plan you can only switch during the Annual Enrollment Period (AEP), which is October 15th-December 75th, unless you have guaranteed issue. When a supplement plan you can change your plan anything during the year but you would have to go through health underwriting prior to being accepted. Some states have Special Open Enrollment Periods.
Which Plan Has Coverage for My Prescriptions Drugs
- Yes, with an Advantage plan most have built in drug coverage, but it may not be the coverage you need. With a supplement plan, you don’t get drug coverage. However, you can add a standalone drug plan to your supplement plan. This can give you more coverage then just an Advantage plan would.
Which Plan Covers Dental, Vision or Hearing
- Some advantage plans cover routine eye care, hearing and dental care but the benefits are limited. With a supplement plan you would add a stand alone dental, vision and hearing plan, also known as DVH, to get this coverage. Again, having a supplement plan with a stand alone DVH will get you more coverage then just an Advantage plan.
You can only enroll in a MA plan if you’re enrolled in Part A and Part B of Original Medicare, don’t have end-stage renal disease and are a resident of the service area the plan covers. With Medicare Supplement plans it’s highly recommended to enroll during your Open Enrollment Period, which runs within the first six months from the first day that you acquired both Part B & are at least 65 years old. If you enroll after this period you’re not given guaranteed issue, this means a carrier can deny you coverage or charge you a higher premium due to pre-existing health conditions.
Medicare Supplements provide benefits such as deductibles, co-payments, and coinsurance. Some companies cater for the emergency care provided out of the country. Medicare Advantage may require you to pay deductibles, coinsurance, and co-payments.
How Do I Choose
The different benefits of the two policies make one plan ideal in one situation but fail to work in another. Our skilled professionals will help you choose the best plan depending on your budget and healthcare needs. Some of the factors that you should consider while choosing the best insurance plan include:
- Lifestyle choices: Medicare Supplement plans provide emergency services for anyone traveling out of the United States for up to 60 days. Additionally, the plan is also open for use in any hospital in the 50 states that offers Medicare services. MA limits this coverage depending on your location.
- Budget: MA costs are slightly lower, but have less benefits. Medicare Supplements have higher monthly premiums but no or very little out-of-pocket expenses.
- Location and Choice: MA plans limit you to the on-network doctors and facilities. The plan may fail to cover any healthcare service provided out of network too. Medicare Supplements provide coverage for any healthcare provided by any doctor or facility that offers Medicare.
Other Resources to Use
To learn more about Medicare Supplement plans and/or Medicare Advantage plans please read our FAQ pages here. We also publish news and tips to our blog regularly for your convenience. To speak to a licensed agent about what plan is best for your individual healthcare needs, please call the number above or get started now by filling out our online rate comparison form to have an agent compare the rates in your area with the top carriers.